Society's marginalised die much earlier-new research

Mortality of women on the margins 12-times that of the rest

Sex workers, homeless, prisoners, hard-drugs users die early

Poverty a big factor in death, living on margins accelerates it

People excluded from mainstream society in developed countries are eight-to-12-times more likely to die an early death than the rest of the population, according to research published in leading medical journal, The Lancet.

The research, led by academics from University College London and released on Sunday, puts hard data behind what might be at first glance an obvious conclusion that those pushed to the margins have worse lives than the more fortunate.

The disparity in death rates is enormous. Yet the research also says that more effective collaboration between government, health services and social care providers can help tackle the disparities that lead to such outcomes.

“This new research shows the frightening extent of the problem: it’s much worse than we thought,” said the lead author Dr Robert Aldridge of UCL’s Institute of Health Informatics.

UCL worked with homeless health charity Pathway, and international experts.

One paper – the first of its kind, according to its authors – highlights the severe rates of death and disease among some of society’s most downtrodden groups. Researchers analysed data from 38 countries, including the UK, the United States, Sweden, Australia and Canada.

The average mortality rate among socially marginalised populations they analysed – sex workers, the homeless, prisoners, and hard-drugs users – was almost 12 times higher than the population average for females, and almost eight times that for males.

The systematic research shows, for the first time according to those behind the study, that these figures far outstrip the already-elevated death rates for people between the ages of 15 and 64 living in the poorest parts of England and Wales: low-income females are almost three times as likely to die an early death than their more affluent counterparts, while low-income males are just over twice as likely to die prematurely.

Something toxic

Professor Andrew Hayward of UCL’s Institute of Epidemiology and Healthcare, the paper’s senior author, said: “The extent of the disparities in wealthy countries is an affront to our values. Socially excluded groups are the canaries in the mine – they point to something toxic in our society.”

A second paper presents evidence of a range of strategies – including drug treatment, case management, and psychological therapies – that can help save lives and reduce the mortality rates of marginalised groups in high-income countries. However, it also says more research is needed to understand how to tackle exclusion and promote recovery on a structural level among marginalised people.

“We urgently need investment and co-ordination between government, health services and social care providers to deliver high-quality comprehensive services… The inequity we have shown is preventable,” says lead author Serena Luchenski of UCL’s Institute of Health Informatics and Pathway Public Health Fellow.

“The single most important thing we can do to prevent social exclusion is to tackle poverty, particularly amongst children. This is the key structural driver of homelessness and the other forms of social exclusion considered in these papers,” said Professor Suzanne Fitzpatrick, Director of the Institute for Social Policy, Housing and Equalities Research (I-SPHERE) at Heriot-Watt University, and co-author on the second paper.

Additional notes and findings

The first paper is entitled: “Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis”. It is a systematic review and meta-analysis of 7,946 articles, of which 337 studies were included for analysis, published between 2005 and 2015.

The second paper is entitled: “What works in inclusion health: overview of effective interventions for marginalised and excluded populations”. The paper identified 272 potentially relevant systematic reviews of interventions published between 2005 and 2015, of which 77 were included in the final review.

Other important groups that face high levels of social exclusion – such as migrants, transgender populations, and ethnic minorities – were beyond the scope of both papers.

Extreme social exclusion is said to affect at least half a million people in England – seen as a conservative estimate due to the lack of national data – and has been compounded by over half a decade of cuts to social welfare provisions, according to UCL’s Professor Hayward.

Dr Nigel Hewett, medical director of Pathway, secretary of the faculty for homeless and inclusion health, and senior author of the second paper, pointed to austerity as the biggest obstacle hindering collaboration efforts in the UK. “There are already examples of teams working together in the integrated way that is supported by this research… The challenge in the UK is that health, housing and social care are overwhelmed by austerity and find it difficult to develop the capacity to work collaboratively,” Hewett said.

A spokesperson for the UK’s Department of Health said: “Tackling homelessness and social exclusion is a complex issue with no single solution, however… we are bringing in the Homelessness Reduction Act, and have allocated £950 million until 2020 to tackle homelessness and rough sleeping… Whilst outcomes of drug and alcohol treatment remain stable we are not complacent and we have recently introduced a comprehensive Drugs Strategy to help protect those who are most vulnerable.”

‘Housing First’ programs are an effective way to improve homeless peoples’ overall quality of life and reducing crime, according to studies highlighted in the second paper. ‘Housing first’ initiatives provide people without a fixed address with stable housing before addressing addiction or mental health issues. According to a separate report published earlier this week by homeless charity Shelter, there are over 300,000 homeless people living in the UK in 2017.

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